System and method for clinical intelligent agents implementing an integrated intelligent monitoring and notification system

ABSTRACT

A method includes: receiving patient specific data; comparing the patient specific data with reference data; producing alerts when the comparison determines that an event requiring action has occurred; and sending the alerts to care providers. An apparatus that implements the method and a computer readable medium including instructions for performing the method are also provided.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional PatentApplication No. 61/141,730, filed Dec. 31, 2008, and titled “System AndMethod For Clinical Intelligent Agents Implementing An IntegratedIntelligent Monitoring And Notification System”, which is herebyincorporated by reference.

BACKGROUND OF THE INVENTION

Field of the Invention

The present invention relates to systems and methods for monitoringpatient conditions and history and issuing notifications based on suchmonitoring.

Description of the Related Art

Events that trigger a need for patient care management require access toprompt communication of information for sound and prompt decision makingand intervention.

Appropriate dissemination of timely information and the communication ofcritical events and specific details, such as background (historicalinformation) with changing conditions and results, to the appropriatestaff is vital to proactive intervention in patient care.

Effective communication and escalation based on severity and acceptableintervention response, and the automated management of this interventionis essential to effective response to a critical situation or thedevelopment of adverse conditions. The present state of this art is amanual monitoring of complex related information from disparate sourcesand manual monitoring of the progress.

The present state of the communication is informal and tenuous. Ascaregivers are notified, their response and changes in the circumstancesare monitored.

Currently, there does not exist an efficient method to monitor criticalevents in patient care, disseminate the information, and then monitorthe intervention and results, and produce historical reports foranalysis.

SUMMARY OF THE INVENTION

In a first aspect, the invention provides a method that includes:receiving patient specific data; comparing the patient specific datawith reference data; producing alerts when the comparison determinesthat an event requiring action has occurred; and sending the alerts tocare providers.

In another aspect, the invention provides an apparatus including aninput for receiving patient specific data; a data repository havingreference data and trigger criteria; a processor for comparing thepatient specific data with the reference data and issuing alerts whenthe trigger criteria are met; and an output for sending the alerts tocare providers.

In another aspect, the invention provides a computer readable mediumincluding instructions for configuring a computer system to receivepatient specific data; compare the patient specific data with referencedata and trigger criteria; provide alerts when the trigger criteria aremet; and send the alerts to care providers.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawing is a conceptual block diagram of a system in accordance withan embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

In various aspects, the present invention relates to a system and methodfor clinical intelligent agents that monitor complex conditions andpatient history to trigger alerts to an advanced notification system.The system and method can monitor complex situations that affect patientcare and safety, and automatically generate alerts using multiplecommunication routes based on the severity of the situation withescalation capability. As used in this description, a clinicalintelligent agent is a complex database model and application componentthat can be dynamically configured to detect clinical patterns,conditions, events that have occurred or should occur, and/orcombinations of medical criteria to actively seek out impendingconditions/situations in order to proactively react with appropriateremediation, tasks and notification processes.

As shown in the drawing, a typical implementation includes a clinicalintelligent agent engine 100, and an intelligent data repository 200with triggers and multidimensional alert specification capabilities,patient specific XML (Extensible Markup Language) per room 400, areal-time alerting agent with paging 500, an alerting repository 600, anotification/escalation rules repository with response protocol 700,caregiver specific alerts and tasks (which are broad in scope andcontext) routed to a patient at a glance display 800, and a smart roomapplication with receivers 900. The clinical intelligent agent engine100, and the intelligent data repository 200 are collectively referredto as an integrated intelligent monitoring and notification system 300.The integrated intelligent monitoring and notification system can beconfigured in any suitable manner as would be appreciated by one skilledin the art. Utilizing XML format enables seamless integration of datarepositories for both inbound and outbound communication processes aswell as dynamic analysis of the data based on the clinical intelligentagent monitoring criteria.

The clinical intelligent agent 100 includes an input for receivingpatient specific information. It monitors conditions that exist withmultiple dependencies and analyzes the conditions to detect a patternthat can be used to alert staff of potential concern. The patientspecific data can be produced and delivered to the input in accordancewith known techniques, including manual data entry and automatictransfer of information captured by various sensing devices.

The intelligent data repository 200 includes a complex database ofreference data representative of health conditions and safety checkswith related dependencies. The data includes trigger criteria that isused to determine if an event has occurred that requires action. Oncesuch an event is detected, an alert is produced and sent via an outputto an alerting agent. This repository can handle complexmultidimensional monitors. These monitors can be implemented insoftware, and are designed to understand relationships between data andevents without limit to the criteria involved. The monitors can relateto each other as well—the results of one monitor affecting the analysisof another. The monitors can analyze current data and events as well ashistorical events and patterns. The monitors can also analyze facility,tracking and clinical criteria, such as patient precaution orcontamination, who (and when) was in contact with the patient, where thepatient was and when, and relationship with overall facility (overall orspecific to unit and/or room and/or bed) locations and personal as wellas patient stay information—such as length of stay and associated alertsor processes. Additionally, the monitors can analyze the specificresults of tasks and staff utilization and dynamically make assignmentmodifications to meet the demands and improve processes. For instance,these monitors can detect patterns of decompensation (clinicaldeterioration pattern) of a patient to proactively react, provideintervention and alert medical staff of the situation with escalationand notification procedures to automatically trigger at each stageappropriate for the specific pattern of decompensation and patientcondition.

The alerting agent 500 includes software that analyzes medical recordsdata and searches for conditions that meet the alert repositorycriteria. This system allows the collection, synthesis, updating andexchange of information needed to respond to the alert and communicationstate. The alert repository contains both current alerts and historicalalerts. These alerts can be associated with any number of triggercriteria for extensive analysis of the data for decision support, totrigger real-time alerts and detail the current and past environment.The clinical intelligent agent configuration parameters contain theescalation criteria and apply these criteria to the alert or task orevent to determine a current score. These alerts, tasks and events aremonitored to escalate the score and/or notification as appropriate,based on the escalation criteria.

As alerts are produced, an alert is sent to the appropriate notificationsource and repository 600. The response to the alert is monitored andthe alert can be escalated as appropriate using rules stored in arepository 700. Additional situational parameters can escalate or reducethe alert status based on changes in the situation. The escalationprocess uses a monitoring system to evaluate each alert or task or eventand applies an associated algorithm to a plurality of parametersincluding a weighted value, incremental escalation value, multiplier,initial time to trigger, and elapsed time before triggering escalationlevels (unlimited), and associated notification and events/tasks totrigger based on the level (unlimited)—this comprises the current score.These scores are also used to prioritize tasks and to dynamically changeworkload/assignments as well as for historical analysis processing.Notification processes trigger when scores reach defined levels.

As the caregiver enters the room, a patient at a glance screen (PAG) 800can be used to display clinical intelligent agent alerting events 600,current caregiver tasks due within the hour with timestamps for duetime, precautions, allergies and general patient information.

Examples of alerts based on status include: heart patient, medicationschange, labs become abnormal; dialysis patient/heart patient, fluidbalance change, labs abnormal; patient flagged ‘at risk’ due to currentregulatory requirements; and patient flagged ‘at risk’ due to currentindividual hospital initiatives.

In one embodiment, the clinical intelligent agent includes a pluralityof components that can be implemented as software modules that run onone or more computers. The components include an alert event component,a conditions configuration component, and an agent alert patterncomponent.

The alert event component can provide a plurality of functionsincluding: location tracking and trending by facility, unit, room andbed; patient tracking and trending; event time tracking; alert type,mode, categories and time tracking; pattern recognition; historicalrecording and reporting of events; remediation tracking for processimprovement tied to associated conditions and events; dynamiccustomization; historical trending with dynamic abnormal pattern andcondition alerts; dynamic modification of normal and abnormal values;and alert routing and escalation role notification roles to alertassociations.

The conditions configuration component can include data elements withminimum, normal and critical value ranges, and can provide a course ofaction repository.

The agent alert event component can provide a plurality of functionsincluding: pattern conditions; pattern relationships; a notificationmode including notification parties, roles and levels; an escalationmode based on time and events, escalation incremental values, escalationtime periods and stages; and precaution alerts.

The agent alert event component enables location tracking and trendingby specific location, including for example, facility, unit, and roomand/or bed breakdown. Additionally the component enables patienttracking and trending of the alerting events. These events can be timestamped to enable the historical detailed event state.

Alert types, mode and categories can be used to create patternassociations for triggers to create events.

Historic recording and monitoring of these events and patterns can beused to trigger additional alerts and notifications.

Remediation events are also tracked and can trigger process improvementevents.

Components are tied to associated conditions and events which can bedynamically configured.

Events, patterns (normal and abnormal), and associations can bedynamically customized without modification of the application.

Alert routing, escalation, and role notifications are associated witheach alert.

The conditions configuration component facilitates the use of minimum,normal and critical value ranges. These associations can be used totrigger a course of action event as defined in the repository.

The clinical intelligent agent alert pattern component embodies apattern of conditions, relationships, a notification mode, notificationroles, levels and parties, and an escalation mode based on time andevents, escalation incremental weighted values to specify significanceof time to event, escalation time period and stages, and precautionaryalerts.

The clinical intelligent agents (CIAs) respond to a complex repositoryand monitoring system that analyzes a dynamic repository. It acts as anintegrated intelligent monitoring and notification system (IIMNS). It isa large-scale automated communication system integrated into anintelligent database with triggers to provide for accurate patientsituational awareness to the appropriate parties and/or caregiver.

This real-time tracking and notification system is event and datadriven, with triggers for appropriate notification based on severity,incorporating automated escalation capability as well as tracking theintervention status and state of the response. This will result in amore efficient use of resources as well as a more timely response. Sinceall data will be captured, it will be available for historical eventanalysis using statistical algorithms to improve/enhance responsemeasures and protocols based on past experience.

The above description describes a system and method for improvedtracking and notification of patient condition and safety concerns. Thefunctions illustrated in the FIGURE can be implemented in a computer orcomputer system, that is programmed to perform the functions andincludes the hardware needed to input, store and process the data, andto produce alerts in the described method. In one embodiment, theinvention can be implemented using a computer readable medium includinginstructions for configuring a computer system to receive patientspecific data; process the patient specific data; provide alerts whenthe processing determines that action is needed; and notify careproviders when the processing determines that action is needed.

While the invention has been described in terms of several embodiments,it will be apparent to those skilled in the art, that various changescan be made to the described embodiments without departing from thescope of the invention as set forth in the following claims.

What is claimed is:
 1. A method comprising: receiving, at a clinicalintelligent agent, patient specific data comprising room location of apatient within a healthcare facility, at least one care provider havingcontact with the patient in the room location, and information regardingthe condition of the patient in the room; storing, at an intelligentdata repository of the clinical intelligent agent, the patient specificdata in a repository, the repository storing reference data includinghistorical patient information derived from an electronic medicalrecord; using a processor to compare, using a monitor of the clinicalintelligent agent, patient specific data with the reference data todetect clinical patterns and to identify an alert situation, wherein toidentify an alert situation comprises detecting a pattern ofdecompensation with respect to the patient; producing, using an alertingagent of the clinical intelligent agent, one or more alerts when theprocessor identifies a clinical pattern using the patient specificinformation and the reference data indicating an alert situation,wherein each alert situation is associated with a pattern ofdecompensation; sending, using agent, the one or more alerts to an alertrepository of the clinical intelligent agent; storing the one or morealerts in the alert repository as one or more historical alerts forinclusion with the reference information; sending, using the alertingagent, the one or more alerts to a patient screen located in the roomoccupied by the patient and accessible to the at least one careprovider; providing, using the clinical intelligent agent, a score to atleast one alert situation identified, wherein the providing a scorecomprises applying escalation criteria to the detected pattern ofdecompensation; prioritizing, using the clinical intelligent agent, careprovider tasks displayed in the patient screen to dynamically change oneor more of a workload and an assignment based on the score; and as theat least one care provider enters the room, displaying on the patientscreen located in the room current tasks for the at least one careprovider and patient specific information for the patient in the room.2. The method of claim 1, wherein the processor determines if thepatient specific data exceeds trigger criteria in the reference data. 3.The method of claim 1 wherein the step of sending the one or more alertscomprises: using predetermined notification rules to set a notificationprotocol for sending at least one of a page, e-mail or telephone call tocare providers.
 4. The method of claim 1, further comprising: trackingand trending events identified by the processor based on a comparison ofthe patient specific data with the reference data.
 5. The method ofclaim 4, wherein the events are time stamped to enable a historicaldetailed event state.
 6. The method of claim 5, further comprising:creating pattern associations for triggers used to identify the events.7. The method of claim 4, further comprising: recording and monitoringthe events and patterns to trigger additional alerts.
 8. The method ofclaim 1, further comprising: tracking remediation actions to identifyprocess improvements.
 9. The method of claim 1, further comprisingsending additional alerts using one or more of a plurality ofcommunications routes based on a severity of the situation in accordancewith escalation rules indicating a changed patient condition.
 10. Themethod of claim 1, wherein the alert situation is based on one or moreof a current regulatory requirement and a current individual hospitalinitiative.
 11. The method of claim 1, wherein the alert situation isbased on a current individual hospital initiative.
 12. The method ofclaim 1, wherein at least one of the care provider tasks is organized inthe patient screen as due within a predetermined time period andincludes a time stamp for due time.
 13. A system, comprising: a patientat a glance screen located in a patient room having a patient therein;and a monitoring system comprising a clinical intelligent agentoperatively connected to the patient at a glance screen; the monitoringsystem automatically acting to: as a caregiver enters the room, displayon the patient at a glance screen: one or more alert events generated byan alerting agent of the monitoring system and specific to the patientcurrently in the room, wherein the one or more alert events aregenerated based upon comparing a current condition of the patient withhistorical patient information to identify a clinical pattern ofdecompensation with respect to the patient; current caregiver tasksspecific to the patient currently in the room and due within apredetermined time with timestamps for due time, wherein the currentcaregiver tasks are organized based on the one or more alert events,wherein the current caregiver tasks are based upon a score determined byapplying escalation criteria to the identified clinical pattern ofdecompensation; and at least one item of patient information specific tothe patient currently in the room and selected from the group consistingof precaution information and allergy information.